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JSES Reviews, Reports, and Techniques Aug 2022Several bone morphological parameters, including the anterior acromion morphology, the lateral acromial angle, the coracohumeral interval, the glenoid inclination, the...
BACKGROUND
Several bone morphological parameters, including the anterior acromion morphology, the lateral acromial angle, the coracohumeral interval, the glenoid inclination, the acromion index (AI), and the shoulder critical angle (CSA), have been proposed to impact the development of rotator cuff tears and glenohumeral osteoarthritis. This study aimed to develop a deep learning tool to automate the measurement of CSA and AI on anteroposterior shoulder radiographs.
METHODS
We used MURA Dataset v1.1, which is a large publicly available musculoskeletal radiograph dataset from the Stanford University School of Medicine. All normal shoulder anteroposterior radiographs were extracted and annotated by an experienced orthopedic surgeon. The annotated images were divided into train (1004), validation (174), and test (93) sets. We use for U-Net implementation and framework for training the model. The test set was used for final evaluation of the model.
RESULTS
The mean absolute error for CSA and AI between human-performed and machine-performed measurements on the test set with 93 images was 1.68° (95% CI 1.406°-1.979°) and 0.03 (95% CI 0.02 - 0.03), respectively.
CONCLUSIONS
A deep learning model can precisely and accurately measure CSA and AI in shoulder anteroposterior radiographs. A tool of this nature makes large-scale research projects feasible and holds promise as a clinical application if integrated with a radiology software program.
PubMed: 37588867
DOI: 10.1016/j.xrrt.2022.03.002 -
Arthroscopy Techniques Oct 2015Synovial chondromatosis of the shoulder is an uncommon disorder. It usually affects the glenohumeral joint and is characterized by metaplasia of the synovium leading to...
Synovial chondromatosis of the shoulder is an uncommon disorder. It usually affects the glenohumeral joint and is characterized by metaplasia of the synovium leading to the formation of osteochondral loose bodies. Few cases of extra-articular subacromial synovial chondromatosis involving the rotator cuff tendon have been reported in the literature. The treatment of previously reported cases consisted of open bursectomy and removal of loose bodies. We report a case of subacromial synovial chondromatosis without rotator cuff involvement but with severe erosion and fracture of the acromion. Treatment consisted of shoulder arthroscopy to remove all loose bodies, total bursectomy, and debridement of the acromion. Potential benefits of arthroscopy were also evaluated.
PubMed: 26697302
DOI: 10.1016/j.eats.2015.04.001 -
Frontiers in Surgery 2022Proximal humeral migration is common in patients with rotator cuff tears. In this study, we aimed to evaluate the relevance between proximal humeral migration and some...
BACKGROUND
Proximal humeral migration is common in patients with rotator cuff tears. In this study, we aimed to evaluate the relevance between proximal humeral migration and some rotator cuff tear-related factors.
METHODS
A total of 75 patients with unilateral rotator cuff tears were retrospectively included from August 2016 to January 2018 who underwent magnetic resonance imaging and X-ray examinations before enrollment. We introduced the upward migration index (UMI) to stratify the patients into three groups, Group A: 1 < UMI ≤ 1.3; Group B: 1.3 < UMI ≤ 1.4; and Group C: UMI > 1.4. Pearson correlation analysis and logistic regression analysis were used to evaluate the relationship between UMI and age, sex, body mass index, pain, fatty degeneration grade, tear size, and thickness of ruptured tendon. Then, the test and receiver operator characteristic curve were applied to measure the diagnostic value of UMI.
RESULTS
The average UMI was 1.34 ± 0.07, ranging from 1.16 to 1.48. For the Pearson correlation analysis, there was a negative correlation between UMI and tear size ( = -0.68, < 0.01), and also, there was a negative correlation between UMI and the visual analogue scale score ( = 0.342, < 0.01). What is more, there was a negative correlation between UMI and the fatty degeneration grade ( = -0.373, < 0.01). Ordinal multinomial logistic regression analysis indicated that tear size ( = -1.825, < 0.001) was the independent predictor of UMI, which was a risk factor for humeral upward migration. The cutoff points of UMI were 1.38 and 1.3 to determine tears and distinguish large tears from small ones.
CONCLUSIONS
UMI is a good predictor for humeral upward migration, which is related to the tear size of posterosuperior cuff tears. When the UMI is <1.3, a large tear should be alerted. Combining physical examination and X-ray is helpful for evaluating rotator cuff tears.
PubMed: 35599789
DOI: 10.3389/fsurg.2022.903538 -
Joint Diseases and Related Surgery 2022The aim of this study was to investigate the stresses on the plate and the clavicle in the standard clavicular hook plate model and the clavicular hook plate models with...
OBJECTIVES
The aim of this study was to investigate the stresses on the plate and the clavicle in the standard clavicular hook plate model and the clavicular hook plate models with a coracoclavicular (CC) screw by finite element analysis (FEA).
MATERIALS AND METHODS
The FEA models were created with the combination of acromion, clavicle, coracoid process, 8-hole clavicular hook plate and screw components. Model 1 was created as a standard clavicular hook plate model and plates were implanted to the clavicle and the acromion by six locking screws. Model 2 was created by a cortical screw placed in the coracoid process through the third hole of the plate (CC screw) and fixation of hook plate by five locking screws. The upward-pull force was applied to clavicle at the insertion of sternocleidomastoid muscle with three axes. The stress exerted by acromion on the hook of the plate, stresses on the plate, clavicle, and CC screw were analyzed.
RESULTS
When the screw holes were compared, in Model 1, the highest stress was found in the last hole of the plate. In Model 2, the highest stress was detected on the CC screw. The stress on the clavicle was found to be 0.14 Mpa in Model 1 and 0.21 Mpa in Model 2. In Model 1 and Model 2, the stress exerted by acromion on the subacromial part of the plate was found to be 2.05 KPa and 1.66x10-6 KPa, respectively.
CONCLUSION
The results of this study show that addition of CC screw to the standard clavicular hook plate shares the loading and reduces the stress on the hook of the plate.
Topics: Finite Element Analysis; Fracture Fixation, Internal; Bone Plates; Clavicle; Bone Screws
PubMed: 36345189
DOI: 10.52312/jdrs.2022.837 -
BMC Musculoskeletal Disorders Nov 2023The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and...
BACKGROUND
The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion.
OBJECTIVES
This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography.
STUDY DESIGN & METHODS
Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values.
RESULTS
CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001).
CONCLUSION
Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement.
LEVEL OF EVIDENCE
III.
Topics: Humans; Acromion; Rotator Cuff Injuries; Rotator Cuff; Shoulder; Shoulder Impingement Syndrome; Shoulder Joint
PubMed: 37968608
DOI: 10.1186/s12891-023-06957-y -
Orthopaedics & Traumatology, Surgery &... Jun 2023Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but...
BACKGROUND
Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA.
METHODS
A single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared.
RESULTS
Humeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications.
CONCLUSION
No clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors.
LEVEL OF EVIDENCE
IV; Case Series.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Treatment Outcome; Shoulder; Humerus; Range of Motion, Articular; Retrospective Studies
PubMed: 36470370
DOI: 10.1016/j.otsr.2022.103502 -
PloS One 2021Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially...
Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
Topics: Acromion; Aged; Arthroplasty; Female; Humans; Male; Middle Aged; Retrospective Studies; Rotator Cuff Injuries; Shoulder Joint; Treatment Outcome
PubMed: 34191814
DOI: 10.1371/journal.pone.0253282 -
Yonsei Medical Journal Dec 1992A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures,...
A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good.
Topics: Acromion; Adolescent; Adult; Aged; Arthroscopy; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Movement; Pain; Postoperative Period; Radiography; Retrospective Studies; Shoulder
PubMed: 1309016
DOI: 10.3349/ymj.1992.33.4.357 -
Reumatismo 2005Milwaukee shoulder is a well defined clinical entity that can be observed in particular in older women. It is a destructive arthropathy associated with the deposition of...
Milwaukee shoulder is a well defined clinical entity that can be observed in particular in older women. It is a destructive arthropathy associated with the deposition of calcium pyrophosphate dihydrate crystals, characterized by the presence of large amount of synovial fluid and a complete tear of the rotator cuff. Clinical features include pain, swelling and progressive functional impairment. The first-line treatment include the use of analgesic drugs and repeated arthrocentesis followed by intra-articular steroid administration; closed-needle tidal irrigation has been reported to be useful. In late phase we can observe narrowing of the acromion-humeral and of the gleno-humeral joint and progressive degenerative changes at the humeral head, leading to almost complete functional impairment. In these cases a surgical approach with total shoulder arthroplasty may be considered.
PubMed: 15983629
DOI: 10.4081/reumatismo.2005.69 -
Journal of Orthopaedic Surgery (Hong... 2022No evaluation has been done on the relationship of the acromion-greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our...
BACKGROUND
No evaluation has been done on the relationship of the acromion-greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our purpose was to evaluate whether a higher ATI is associated with retear after ARCR.
METHODS
132 patients received ARCR and underwent MRI scan at a one year follow-up to assess tendon healing, and the findings were graded no retear (NR), partial-thickness retear (PR) or full-thickness retear (FR). The ATI, the critical shoulder angle (CSA), acromion index (AI) and lateral acromial angle (LAA) were measured with postoperative radiographs. Functional scores were obtained preoperatively and at a one year follow-up.
RESULTS
Postoperative Constant scores and ASES scores were significantly different between groups with inferior outcomes in the FR group ( < 0.05 for all). The UCLA score was significantly better in the NR group compared with the PR and FR groups ( < 0.05), and in the PR group compared with the FR group ( < 0.05). For ATI and CSA, the values of the PR and FR groups were larger than the NR group ( < 0.05 for all), but there were no significant differences between the PR and FR groups ( > 0.05 for all). No significant differences were observed with regard to the AI and LAA ( > 0.05, respectively). The repair integrity was positively related to the ATI (0.304, < 0.05) and CSA (0.252, < 0.05), but not related to the AI or LAA ( > 0.05 for both). ATI was not related to any functional scores ( > 0.05 for all).
CONCLUSION
This study revealed that the ATI was positively related to rotator cuff retear. Patients with retears had significantly greater ATIs after ARCR. Level of Evidence: III, case-control study.
Topics: Acromion; Arthroscopy; Case-Control Studies; Humans; Magnetic Resonance Imaging; Recurrence; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 35430906
DOI: 10.1177/10225536221092219